Provider Demographics
NPI:1982994430
Name:NOETIC, INC.
Entity Type:Organization
Organization Name:NOETIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-215-2984
Mailing Address - Street 1:310 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-1711
Mailing Address - Country:US
Mailing Address - Phone:248-215-2984
Mailing Address - Fax:
Practice Address - Street 1:310 E 3RD ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-1711
Practice Address - Country:US
Practice Address - Phone:248-215-2984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-18
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI03583FMedicaid